الفهرس 
Acknowledgements
Risk factors and mechanisms of development of glaucoma in uveitic patientsOnly 14 pages are availabe for public view
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Abstract
6.1 Chapter1: (Outcome of trabecular microbypass Istent Inject as A novel technique in uveitic glaucoma). Due to hypotony and its complication of choroidal effusion, corneal decompensation and hypotony maculopathy that occurs in about forth to third of cases in external filtering antiglaucoma surgeries specially using with valve implants. Also, due to the wide safety scale of trabecular Istent in managing open angle glaucoma in literature. We decided to council the patient to use the Istents with or without phaco in Uveitic glaucoma patients with no significant peripheral anterior synechia. This series of eight patients showed a substantial mean reduction in IOP at 1 month with a mean fall of 16.2mmHg from 33mmHg to 16.8mmHg, despite a withdrawal of oral acetazolamide and reduction in topical ocular hypotensive medications postoperative. Importantly this reduction in IOP was sustained at 6 months (mean of 17.5mmHg) and showed only marginal elevation at 12 months (mean of 19.5mmHg); the only adverse event (macular oedema) is not thought to have been a consequence of the iStent procedure, being more likely related to the concurrent cataract surgery. No hypotony, hyphaemia or early dislocation of Istent was recorded in our case series, and this gave our patients a great element of satisfaction postoperative by bypassing vision threatening complications that might happen postoperative after conventional antiglaucoma surgeries as Our patient’s visual acuity was varying between 6/6 and 6/9. In our series, the mean DROP in intraocular pressure at 4 months was 54% which compares favourably to the majority of literature and IOP control was maintained in all our case series till 12 months. Although we admit that the short follow up period for 12 months to eight uveitic patients and 24 months to few of them is our weak point, It still an achievement to confirm success of Istent in uveitic glaucoma patients with very high IOP even if it is qualified success not complete success. We recognise that the reduction in IOP achieved with an iStent implantation procedure is likely to be less than more invasive procedures such as augmented trabeculectomy or tube insertion. Our study however provides support for its use even in the complex situation of uveitic glaucoma, and that successful reduction of IOP is sustained over 12 months without the early failure that might be expected in an inflammatory milieu. In our study all patients did require at least one ocular hypotensive DROP post-surgery, but all patients were on less medical therapy than pre-operatively. Despite limitations of our study being retrospective, small case series, short follow up foe 12 months only, It confirms that we can use istent to control IOP in UG patients which was contraindicated since the era of using istent in glaucoma. This is the first study to prove efficacy of istent use in UG patients even if it aimed at qualified success instead of complete success. 6.2Chapter2: (Outcome of trabeculectomy with MMC in UG group versus POAG group). Although trabeculectomy with MMC is very common and standard primary antiglaucoma surgery for medically uncontrolled glaucoma, there are very few number of literature comparing the outcome of trabeculectomy with MMC as a primary surgical intervention for POAG versus UG without concurrent cataract surgery at the same time as trabeculectomy operation. We can easily find outcomes for trabeculectomy with MMC in either of the two groups in separate studies, but it is very few to find comparative studies published on uveitis cohort in general (without specifying certain cause of uveitis) with good number of cases and longer follow up time postoperative. We recorded IOP level for two groups of patients (60 primary open angle glaucoma patients and 60 uveitic glaucoma patients) preoperative, first year postoperative, third year postoperative, and fifth year postoperative. That enabled us to detect the outcome regarding success rates and failure rate in each group against postoperative time. By the first year postoperative, the group of POAG patients recorded complete success rate at 41.7% which is 5% higher than that of uveitic glaucoma patients. However, the qualified success rate for POAG group was less than the qualified success in uveitic glaucoma group at 51.7% and 53.3% respectively. With regards to the failure rate. Only 6.7% of POAG group recorded as failed surgery in comparison to 10% failure rate among the uveitic glaucoma group. By looking at the third year postoperative results, it is obvious that both POAG and UG groups showed increase in the qualified success rate by10% and decrease in the complete success rate by 10% but the failure rate was nearly the same as the first year postoperative. At the fifth year postoperative, POAG group continued to record decline in the complete success rate to reach 28.6% and qualified success rate continued to increase reaching 64.3% with mild increase also in the failure rate to reach 7.1%, Similarly uveitic glaucoma group showed decrease in complete success rate to reach 17.9% and increase in both qualified success and failure rates at 71.4% and 10.7% respectively. There was no statistically significant difference regarding success and failure rates between our POAG and UG cohort for five years postoperative. There is a high statistically significant difference in IOP level preoperative between POAG group and UG group at P value of 0.000. At the first and third postoperative, there was no statistically significant difference in IOP between POG and UG groups with p value of 0.79 and 0.48, respectively, while p value between the two groups at the fifth year was significant at value of 0.008. This shows that also the early result of trabeculectomy with MMC may be nearly equal in the first year postoperative in both POAG group and UG group, however the results showed a significant difference in IOP level in POAG patients and UG patients by time. Also, there is rate of conversion from complete success to qualified success after the first year postoperative. Despite limitations of our study such as, being retrospective, not including aetiology of uveitis in UG cohort, not including race or lens status of patients included to detect potential prognostic factors. The clinical implications for this study include two main points. Firstly, follow up is important and we must council the patient that no need for antiglaucoma medications to control IOP for the first year postoperative does not guarantee that they will not need to add antiglaucoma medication in the future to control their IOP. This is obvious in both POAG group and UG group, so close follow up to ensure good control of IOP is mandatory for years postoperative and almost rest of life even if the patients had surgeries done and confirmed complete success in the early postoperative time. Secondly, outcome of trabeculectomy with MMC is similar in UG to POAG, and not worse than many ophthalmologists think. So, we can safely go for primary trabeculectomy with MMC for UG patients without counselling them about possibility of going through valve as initial external filtering surgery that carries higher risk of complications.